Theft Declaration Form

We are providing you with a Claim Form to fill in case you have to report any loss or damage covered under your policy.

In this Department, even though declaring the event should be made within 72 hours after the Loss, this declaration could be made either by telephone or by fax to make it quick, but it is still necessary to fill in a Claim Declaration Form. For this reason, we are providing you with this form just to put you in the mood of what could we ask you about in terms of declaration thus relieving you from the move.

PS: Fields marked with a (*) are required.
Policy Holder *
Address
E-mail *
Phone Number
Policy Number *
Address of Risk
Was there any Forcible Entry	Yes No
Time and date of loss	HH:MM dd/MM/yyyy
Time of arrival of Police	HH:MM
Was there any Police Report	Yes No
Expert Name
Brief Description of Losses and Damage Occurred
List & Estimate of Losses in US$

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